Jay's Anatomy

"Oh, you know," she replies. "Everybody's dying." ast month marked the clinic's third anniversary, but it's a rare student who can still remember Jenni Koontz, who floated the idea of a free, student-run clinic in the spring of 2002. A hundred of Koontz's fellow KU Med students rallied around the idea, securing $60,000 in startup funding from the Association of American Medical Colleges. They approached Lee, who operates a sliding-fee-scale clinic where 40 percent of the patients are uninsured, and easily talked her into allowing the Jay Docs to operate out of her facility on Monday evenings.

The first night, 20 people showed up. Soon, lines started forming outside every Monday. It took only a year for the clinic to expand to two nights a week.

"In the last year and a half, I can't think of a night that we didn't have more patients than we could see," Obley says.

The clinic operates just three hours at a time, so there's no guarantee that every person will receive treatment. Numbers scrawled on Post-it notes dictate the triage order. But as the student doctors are well aware, these patients are willing to wait and take their chances.

About 190,000 residents in the eight-county Kansas City region do not have health insurance, according to a July report commissioned by the Mid-America Regional Council. The Jay Docs serve a tiny fraction of those patients, often turning away as many as they treat.

There aren't many other places for their patients to go. Throughout the metro, free or reduced-fee medical services are available at eight county health departments; another 15 clinics provide general health care services for uninsured and low-income residents.

But Lee says there are barriers to access even at safety-net clinics such as her practice on Southwest Boulevard. Some clinics require daytime appointments, which people can't make because they can't leave work or have kids to take care of, she says. For some patients, even a fee of $10 puts health care out of their price range. Then there's the simple problem of capacity. The KU students quickly learned that referring Jay Doc patients to other clinics, in hopes that they would receive longer-term, consistent care for chronic conditions like diabetes, wasn't doing much good. Instead of establishing relationships with doctors, the patients would sit on waiting lists, often for months.

Forty percent of uninsured Missourians and 45 percent of uninsured Kansans were unable to see a doctor when they needed care in 2004 — a low enough number to give Kansas the 11th-worst ranking in the nation, according to an April report from the State Health Access Data Assistance Center at the University of Minnesota.

Adam Leight, a resident in KU's family-medicine unit and volunteer physician at Jay Doc, isn't surprised by such a lack of access. Back in San Antonio, Texas, where he started his medical training, uninsured residents had access to a county hospital system and county-sponsored health insurance. Not so in the City of Fountains. On the Missouri side, uninsured people can seek care at the publicly funded Truman Medical Center, he points out. But in Wyandotte County, residents of Kansas' poorest county per capita have no hospital to serve them.

"Since coming to Kansas City, I've been variously puzzled, saddened and frustrated by the burden of untreated disease in the community," he says.

Because of that burden, the Jay Doc clinic faces a difficult task. As second-year student David Harmon puts it, "Our patient population isn't the normal, suburban, he-has-a-cough, mommy's-here-with-him, everything's-fine type of crowd."

One July night, that crowd includes a Latino woman who has been self-medicating seven months of back pain with pills from Family Dollar. A rash creeps down her legs. In the next room, an obese diabetic recovering from heart surgery applies for assistance to receive the eight medications he needs.

The students try to keep patients cycling through at a brisk pace. They know the woman in the third exam room has been waiting for three hours and has promised her daughter ice cream afterward to try to sweeten the kid's growing impatience. But the Jay Docs are often tripped up by barely adequate resources.

Nick Stucky, a second-year student who handles the Jay Doc's finances, says it costs an average of $3,500 to keep the clinic going each month. Those funds go to the reduced rent they pay Lee, the lab tests they send off-site and the oversized bottles of generic medication that fill a large plastic tub in the back office. Last year, operating costs were covered by a grant from the Wyandotte Health Foundation, and last month the group secured a similar grant from the Health Care Foundation of Greater Kansas City to pay the clinic's operating expenses through mid-2007.